Pre Surgical Tour Online Registration Form

Thank you for your interest in attending our Pre-Surgical Tour. It is recommended that your child attend the tour the Sunday before their surgery. Please fill out the registration form below. If you arrive later than 15 minutes after the tour start time we cannot guarantee that we can provide you with a tour.

The Sunday tour begins promptly at 2:00pm and typically lasts a little over an hour— please arrive at the main hospital (111 Michigan Avenue, NW) 15 minutes prior to the start of the tour (there is a form you will need to fill out). Tours are offered every Sunday, except holidays.

Please respond to the following questions.

Child Information

First Name:

*

Last Name:

*

Date of Birth:

MonthDayYear

Parents/Caregivers Information

First Name:

*

Last Name

*

Email:

*

Home Phone:

*

Cell Phone:

Surgery Related Information

Type of surgery your child is having:

*

Date of your child's surgery:

*

First choice for tour date:

Please note it is recommended that you attend the tour the Sunday before your child’s surgery

*

Number of people attending to this tour:

If your child is under 3 years old and you plan to bring them on the tour please have an additional family member with you to be with your child if they need a break.
If you would like to bring siblings we ask that you bring children that would benefit from attending the tour i.e. - they have questions/concerns about their siblings surgery etc. If they are under the age of 5 and you need to bring them on the tour please have an additional family member on the tour to sit with them if they need a break.

*

Surgeon’s name who will be performing the surgery:

*

Interpreter and language assistance needed:

YesNo

*

Are they developmentally on target?

YesNo

*

Previous Hospital/Surgical Experience

How do they do in the Dr.’s office- especially if they have had no previous hospital experience. Are they afraid of the Dr. etc.?

*

What do they know about their upcoming surgery?

*

How did you find out about the tour?

*

We make every effort to make this a fun, relaxing experience for the entire family. Please let us know if you have any additional questions etc.

Children's National in Your Neighborhood

Did you know our team sees children in Annapolis, St. Mary’s, and Salisbury?